| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
747 |
212 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
119 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
73 |
72 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
66 |
56 |
$3K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$1K |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
50 |
$954.72 |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
45 |
$790.34 |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
31 |
$739.20 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$195.00 |
| D1330 |
|
66 |
66 |
$0.00 |